“Natural orifice surgery: The next step in minimal invasiveness towards no scar surgery.”

Forgione, A. (2009).

Minerva Chirurgica 64(4): 355-364.

The possibility to operate into the abdominal cavity by means of flexible endoscopes introduced through natural orifices represents a major step forward in the continuous research for minimal invasive treatment attaining the unimaginable goal of no scar surgery. After several years of investigation in experimental settings, natural orifice surgery is becoming a valuable therapeutic option both as totally transluminal endoscopic approach or with the support of minimal transabdominal assistance. The promising operative results and the great interest determined among the patients always looking for effective treatment associated with less bodily trauma, postoperative pain and faster recovery, are pushing the development of dedicated technological solutions that will make natural orifice – no scar surgery more easy and reproducible to perform and applicable also to more advanced diseases. Natural orifice surgery has the potential to abolish the historical association of surgery to that of scar and pain representing a very appealing surgical option for the patients highly respectful of their body and psychological integrity.

“Consensus statement of the consortium for laparoendoscopic single-site surgery.”

“Optimization of a novel mechanism for a minimally invasive surgery robot.”

Li, J., S. Wang, et al. (2009).

Int J Med Robot.

BACKGROUND: Minimally invasive surgery (MIS) has many advantages compared with open surgery, but there are still many drawbacks in performing MIS. Using robotic technologies, many problems caused by human restrictions, such as fatigue and low precision, can be solved. In this paper, a novel mechanism for a MIS robot is proposed. METHODS: Kinematics analysis was carried out and singularity and isotropy configurations were also investigated, based on kinematics equations. In order to evaluate the performance of the robot, a combined measure gave attention to the mean value and standard deviation of the reciprocal of the condition number. Optimization was achieved by maximizing the combined measure subjected to a set of constraints in the task workspace. The effectiveness of the measure was demonstrated by comparing the performance and volume of the optimized mechanism with those of the mechanism optimized by the Global Condition Index (GCI). RESULTS: The robot met the volume constraints with the dimensional parameter a </= 115 mm. The combined measure varphi was maximized when a is 100 mm. The robots optimized by the GCI and the combined measure showed similar performance in terms of condition number, but the latter had advantages on volume compared with the former. CONCLUSIONS: A novel mechanism that satisfied the incision point constraint of MIS was proposed. A systematic methodology for optimizing the mechanism was developed and the combined measure was effective to evaluate the performance. A prototype was set up based on the outcomes mentioned in the paper. Copyright (c) 2009 John Wiley & Sons, Ltd.